Great Occipital Nerve Block Using Different Approach

Not Applicable

Recruiting

• Conditions: Pain, Chronic
• Interventions: Procedure: Greater occipital nerve block

• Registration Number: NCT06149299
• Lead Sponsor: Keimyung University Dongsan Medical Center

Brief Summary

Great occipital nerve (GON) block is commonly applied for the pain management of occipital neuralgia, migraine, and cervicogenic headache. The GON orginates from the medial branch of the dorsal ramus of the C2 spinal nerve with variable contribution from the C3 dorsal ramus. After emerging from the suboccipital triangle, the nerve courses cephalad in an oblique trajectory between the semispinalis capitis (SC) and obliqus capitis inferior (OCI) muscles. This area was recognized as a potential location for GON injury. The nerve then passes through the trapezius muscle and courses medial to the occipital artery as it ascends to innervate the posterior scalp.

Many practitioners perform GON injections using a conventional approach, relying solely on superficial bone-based anatomic landmarks to infiltrate local anesthetic and corticosteroid around the nerve at the level of the superior nuchal line.

Some clinicians also use fluoroscopy to confirm the location of bony landmarks. The ambiguity of these injections poses a risk of anesthetizing adjacent structures or injecting into vessels, such as the occipital artery. Very limited research has been done to quantify the risk of these injections, but a complication rate of 5% to 10% has been reported, including headache, dizziness, blurred vision, and syncope.

Ultrasound guidance is increasingly used to mitigate these risks and improve the efficacy of GON injections. Multiple studies have demonstrated successful ultrasound-guided GON blockade at the superior nuchal line and improvement in pain scores compared with nonguided injections.

C2 level GON block using ultrasound targets interfascial plane between OCI and SC muscles. However, a pain physician who begins ultrasound guided injections migth feel very difficult targeting interfascial plane exactly.

Since GON orginiates from deep space of suboccipital triangle, it is expected that injection within OCI muscle might have similar effect with the effect of injection into interfascial plane.

We assume that if the local anesthetics is injected within OCI muscle, the effect of GON block will be generated by the diffusion of injected local anesthetics.

Detailed Description

Not available

Study Timeline

• Status Verified: 2023-11
• Study Start: 2023-11-13
• Study First Submitted: 2023-11-20
• Study First Submitted QC: 2023-11-20
• Study First Posted: 2023-11-28
• Last Update Submitted: 2023-11-28
• Last Update Posted: 2023-12-04
• Primary Completion: 2024-06-30
• Study Completion: 2024-06-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 24

Inclusion Criteria

• Cervicogenic headache
• Migraine
• Occipital neuralgia

Exclusion Criteria

• bilateral headache
• cervical spine surgery within 1 year before
• loss of sensory sensation at the dermatome of GON innervation
• anatomical defect at the region of procedure
• coagulopathy
• pregnancy or breast feeding
• allergy to local anesthetics

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
interfascial plane group	Greater occipital nerve block	injection into inferfascial plane
intramuscular group	Greater occipital nerve block	injection into obliqus capitis inferior muscle

Primary Outcome Measures

Name	Time	Method
block success	Baseline, 30 minutes after the completion of GON block	block success after GON block
Numerical rating scale	Baseline, 30 minutes, 2 weeks, 4 weeks after the completion of GON block	Numerical rating scale after GON block

Secondary Outcome Measures

Name	Time	Method
Side effect after GON block	Baseline, 30 minutes after the completion of GON block	Side effect after GON block

Trial Locations

Locations (1)

Hong ji HEE; 🇰🇷 Daegu, Korea, Republic of